Wednesday, October 02, 2002

Dealing with lives

Have you ever felt like a fool in front of a doctor? Doctors have this air about them that reduces the most educated and informed patients to speechless fools.

Recently, on my first visit to a consultant gastroenterologist at SGH, I was describing to him my symptoms and saying that I suspected I have IBS, and the first thing he said was, “Who told you that you have this? From this magazine? (I was holding a woman’s magazine to while away the long waiting time) You would rather read all about it in such magazines than come see me….”

No doubt he was trying to “joke” and wasn’t exactly reprimanding….still!

After his examination, he was confirming my suspicion and mentioned that my blood pressure was normal… and I asked, “how was it…” “Normal” he insisted. But what was the level, I wanted to know and it was my turn to insist before he would tell me, “110/60”, and then ordered some blood tests.

A week later I had to go back to him for two scopes. At the end of the procedures, I had to ask how were the blood test results…. “They were good”. Sigh – what does THAT mean?!

On my third visit, to collect the biopsy results of one of the scopes, he managed to cursorily go over the various test findings, rattling on as if it was his “duty” to inform, but without checking for comprehension.

I had been told after the scopes that I would be put on medication for gastric for a month. I was all hopeful during the third visit that I could be rid of it, since the pain had gone and the tablet was not doing much good; instead it was giving me a lot of gas and making me have this “food stuck at chest” feeling.

The consultant would not hear of it. “How come? It’s supposed to make you feel better,” he jumped in barely after I could finish describing, and without even clarifying or probing further. I had to insist on describing the difficulties I felt, the inconveniences, the food that made me worse, etc.

Alas, even if he was forced to hear the kind of food that aggravated me, he was not convinced, let alone bothered. Instead of working with me to find out what exactly caused the bloated feeling, he almost immediately decided to give me two more types of medication for another month. No explanation of what each does, and why.

When I left the room, I suddenly remembered that I still had the previous tablets unfinished (the one month was not over yet) – was I supposed to discard them and take the new ones? And had to go back to ask. Only to find out that I should be continuing it as he was going to prescribe it for yet another month in addition to the two more.

Patients are humans; some are very well-read, well-informed and intellectual, and many are not stupid. In this day and age, they can read books on the conditions they suffer from; they can check the web, they can even have second opinions from different doctors.

Doctors are busy. Hospitals are crowded. That’s why Q’s are long, no one has time to waste and everyone is always in a hurry.

But doctors deal with the lives of patients – humans. Patients have the right to know. And to be listened to, and to hear the rationale, reason, the why’s and how’s of their suffering, and of the treatment and prescription meted out to them.

And just telling them their blood pressure is “normal” is not enough. What constitutes “normal blood pressure” is not rocket science anymore – it is now general knowledge that “normal” means 120/80. And there would be some who want to know the exact range – for monitoring purposes. Even fitness trainers explain and monitor my blood pressure during regular check ups at the gym.

Even my massage therapist spent more time discussing my medical history during my first visit, showed an interest in my condition and enquired about my follow up treatment, all these in a more “empathetic” manner too. Small wonder – for she had been a nurse for 24 years in the UK prior to coming here.

Dr Raphael Kellman in his book on treating chronic stomach distress, Gut Reactions, wrote that he believed in patient education: “it is not enough to hand patients a prescription – and send them their way. It is critical for patients to understand why they are doing what they are doing and for patients to take an active role. In my experience I have found that well-informed patients who are active in the healing process have better outcomes than those who passively accept whatever their doctors may tell them.”

I call them “prescription-happy” doctors. They treat patients robotically – using the classic cause and effect theory – “if headache, take aspirin”. Nevermind if the pain is caused by a knock on the head or a stressful argument with your husband – it is not “healing at the root”.

Wrote Dr Kellman, “I know that any gastrointestinal problem can be healed at the root. Too many people are put on one drug after another and at best, most of the time, the symptoms are just lessened but not completely healed….many people have significant side effects from the drugs or just don’t feel quite right. Others may see an improvement in their immediate problem but a few months later are confronted with a new one”.

He advised that one should find a doctor with the “right mind-set” and “whose goal is to help people on many levels”. He said, “Our all-too-mechanical approach to understanding ourselves in the world is reinforced every time you go to a doctor who hears your symptoms and sends you out the door with nothing more than medicine.”

Lest you think I demand too much, here’s my stand: doctors are not shrinks. They are not expected to hear my intimate woes and personal tales. But they need not be mechanical, impatient and unresponsive. All I ask for is information given coherently, engagement in genuine discussion and appropriate response to feedback, in an unhurried manner. That is, to treat me as an individual, even though my condition may be the 10,000th cases you have dealt with this year in this large hospital with the capacity of treating 100 cases per minute. (read: I am not a number but a human even though I contribute to your impressive statistics)

And don’t forget many patients are also professionals who have to deal with meetings and appointments at work. They do not drop everything at work to be at the mercy of the crazy appointment times that the hospital gives you. Neither can they rush from home (barely waking up in the morning) to the hospital just because the doctor asked the nurse to call to change the appointment less than an hour before the pre-arranged time. Or cancel the office meeting in the afternoon just because, on the follow up visit, the doctor had to re-schedule, yet again.

Sadly, such doctors in Singapore are a rare species. So far, I have only come across two GPs who are like that, and two specialists. I have more personal horror stories on NUH’s O & G Dept as well as on another GP – but that would be too shocking and incredible, and might even entail a National Inquiry!

Having lived and having been treated at hospitals in England, and even at a Sydney hospital in the middle of the night, the experience was a world of difference between there and here. There, they treated you with much respect, and took the trouble to explain and listen. Even my friend who was a medical student in England, and who had to do a stint at NUH, told me the world of difference between there and here. No wonder he did not want to come back, and has stayed and practised there for good.